Axillary lymph node dissection is not routinely indicated in patients with sentinel lymph node residual micrometastases following neoadjuvant systemic therapy

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2026-06-01 Epub Date: 2026-03-03 DOI:10.1016/j.amjsurg.2026.116901

Kinan Mokbel , Kefah Mokbel

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引用次数: 0

Abstract

Background

The clinical relevance of residual micrometastatic nodal disease (ypN1mi) detected in the sentinel lymph node (SLN) or following targeted axillary dissection (TAD) after neoadjuvant systemic therapy (NST) remains uncertain, particularly regarding the need for completion axillary lymph node dissection (cALND).

Methods

This narrative review summarizes evidence from registry-based and international cohort studies evaluating axillary recurrence and oncological outcomes in patients with ypN1mi managed with or without cALND after NST.

Results

Analyses from the SEER registry and the OPBC-07/microNAC cohort demonstrate a low incidence of axillary recurrence and no significant differences in oncological outcomes between SLNB alone and cALND. In subgroup analyses of triple-negative breast cancer, microNAC reported lower axillary recurrence rates with cALND; however, no difference in invasive recurrence was observed between groups.

Conclusions

Routine cALND appears unnecessary in most patients with ypN1mi after NST. Future studies should evaluate whether regional nodal irradiation can also be safely omitted.

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腋窝淋巴结清扫不是常规指在新辅助全身治疗后前哨淋巴结残留微转移的患者

背景：在新辅助全身治疗（NST）后前哨淋巴结（SLN）或靶向腋窝清扫（TAD）中检测到残留微转移性淋巴结病（ypN1mi）的临床相关性仍不确定，特别是是否需要完全腋窝淋巴结清扫（cALND）。方法：本综述总结了基于注册表和国际队列研究的证据，这些研究评估了NST后使用或不使用cALND治疗的ypN1mi患者腋窝复发和肿瘤预后。结果来自SEER登记和OPBC-07/microNAC队列的分析表明，单纯SLNB和cALND的腋窝复发率低，肿瘤预后无显著差异。在三阴性乳腺癌的亚组分析中，microNAC报告cALND患者腋窝复发率较低；但两组间浸润性复发无差异。结论大多数NST后的ypN1mi患者无需常规cALND。未来的研究应评估是否也可以安全地省略局部淋巴结照射。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.